| NPI | 1326896358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA065548) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: NJ 25MP00902700) | |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2025-06-27 |